Background: Diabetes mellitus is characterized by high blood sugar levels over a prolonged period due to alteration in either the insulin secretion, insulin action, or both. Worldwide, as of the recent 2016 data collected from the World Health Organization (WHO) around 422 million adults have diabetes mellitus which is estimated to almost double by 2030 which is composed of mainly type 2 diabetes (85-90% of all cases). The early detection of peripheral artery disease in asymptomatic patients goes a long way in reduction of major lower limb amputations and mortality. Hence, there is a need for evaluation of peripheral vascular disease in all diabetics, especially those with diabetic foot by formulating effective management protocols, thereby limiting the morbidity, mortality and social costs associated with the disease.Methods: Patients admitted and seen in out-patient department for diabetic foot ulcers between January 2013 and October 2013 in Department of general surgery, vascular surgery and diabetology, Kilpauk Medical College Hospital, Chennai, India were taken for study.Results: 150 cases satisfying the inclusion criteria were taken up for the study from January 2013 to October 2013. Out of 150 patients, 76 patients presented with ulcer in foot, 34 presented with gangrene of toe or foot. After clinical examination it was found that 52 patients had associated neuropathy, 17 patients had ABI less than 0.3 and 39 patients had ABI in between 0.4 and 0.9. Patients with ulcer and gangrene in foot and with ABI less than 0.9 were admitted and evaluated with doppler study of lower limbs. After getting consent, appropriate procedure was done for each patient. Wound debridement was done in 21 cases, toe disarticulation in 12, fore foot amputations in 4, Below knee amputation in 9, above knee amputation in 3. 11 patients were referred to vascular surgery and underwent revascularization procedures (BYPASS).Conclusions: The prevalence of peripheral artery disease in patients with diabetic foot is significantly high i.e. 38 % as per this study. Males have a higher predilection for developing peripheral vascular disease than females. The average age of presentation of PAD in diabetics is 40 -60 years. The most common level of arterial occlusion in PAD associated diabetic foot is femoro-popliteal segment followed by tibial segment.
BACKGROUND Nutrients form the fuel for the body, which comes in the form of carbohydrates, proteins and lipids. The body is intended to burn fuels in order to perform work. Starvation with malnutrition affects the postoperative patients and patients with acute pancreatitis. There is an increased risk of nosocomial infections and a delay in the wound healing may be noted. They are more prone for respiratory tract infections. Enteral Nutrition (EN) delivers nutrition to the body through gastrointestinal tract. This also includes the oral feeding. This study will review the administration, rationale and assess the pros and cons associated with the early initiation of enteral feeding. The aim of this study is to evaluate if early commencement of enteral nutrition compared to traditional management (delayed enteral feeding) is associated with fewer complications and improved outcome- In patients undergoing elective/emergency gastrointestinal surgery. In patients with acute pancreatitis. It is also used to determine whether a period of starvation (nil by mouth) after gastrointestinal surgery or in the early days of acute pancreatitis is beneficial in terms of specific outcomes.
BACKGROUNDSwellings of the parotid gland are of special interest to a surgeon's keen eye. These lesions are not only involved in diseases isolated to the parotid, but can also present as a part of a generalised systemic disorder, medical or surgical. For a surgeon, the interests lie in the probable origin of the swelling, its involvement of the facial nerve, the variability in behaviour, regarding the operability criteria and its postoperative complications. 1 A comprehensive knowledge of the anatomy of the parotid and the prediction of the swelling behaviour can help not only in the diagnosis, but also in ensuring an apt management of the lesion and the patient. 2 This cohort study was conducted to analyse the following in our institution. The incidence of various parotid swellings to discuss accuracy of FNAC in comparison to the histopathological reports. The various surgical modalities of treatment of parotid swellings applied. MATERIALS AND METHODSThe cohort study, which included 45 patients was conducted at Kilpauk Medical College Hospital and Government Royapettah Hospital from September 2010 to October 2012. Data was collected from the patients after obtaining an informed consent. The demographic details of the patients and history of their swelling was taken. The patients were examined and basic investigations performed. Details regarding the FNAC report, surgical and nonsurgical management were noted. Postoperative complications were documented. The final histopathological report was analysed and compared with the FNAC report. RESULTSParotid lesions are commonest cases in our study. Benign tumours are more common than malignant lesions. This study found to correlate with world statistics. Investigations, clinical findings and treatment correlate well with world statistical records. CONCLUSIONThe analysis of the data of the study conducted at our institution provided us with the following results-Parotid lesions comprised of the most common salivary gland lesions in our hospital. The sex incidence showed a similar distribution among both males and females with the ratio being 1:1.25. 3 The mean age of presentation was 49 years and it was seen that the 4th and 7 th decades where the predominant age group for occurrence in case of benign and malignant tumours, respectively. 4 These were found to be consistent with the comparison made with world statistics. 5 In the case of malignant tumours, the sensitivity and specificity was found to be 87.5% and 100%, respectively. 6 Completion parotidectomy was performed in 2 cases and both were malignant tumours with recurrence. 7 Facial nerve palsy and seroma formation were the commonest complication noted postoperatively. 8 Radiotherapy was the most common nonsurgical modality used and administered more commonly postoperatively. 9
BACKGROUNDPenetrating abdominal injuries forms an important component of surgical emergencies. It remains one of the commonest reasons for preventable deaths in any trauma systems. 1 Abdominal injuries may be parietal or visceral or perforating through and through injury. Unnecessary exploration leads to increased morbidity. The goal in managing penetrating abdominal injuries is to identify and treat all the damages caused by the weapon and to reduce negative laparotomy and avoid missed injuries. on penetrating injuries abdomen. RESULTSAmong 53 patients, maximum number of cases were in the age group of 30-40 years. Assault injuries account for 87% of cases of penetrating abdominal injuries. Small bowel was the commonly injured organ in this study. Laparotomy was therapeutic in 94% of the cases (64% of the cases underwent laparotomy). CONCLUSIONCareful and serial clinical examination and appropriate diagnostic investigations leads to successful treatment in these patients. Computed tomography is highly sensitive in predicting both peritoneal penetration and intra-abdominal visceral injuries.
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